Progressive and Simultaneous Right and Left Atrial Remodeling Uncovered by a Comprehensive Magnetic Resonance Assessment in Atrial Fibrillation

Author:

Gunturiz‐Beltrán Clara123ORCID,Nuñez‐Garcia Marta45ORCID,Althoff Till F.167ORCID,Borràs Roger128,Figueras i Ventura Rosa M.9,Garre Paz12ORCID,Caixal Gala12,Prat‐González Susanna123,Perea Rosario J.123,Benito Eva Maria12ORCID,Tolosana Jose Maria123,Arbelo Elena123ORCID,Roca‐Luque Ivo123ORCID,Brugada Josep123ORCID,Sitges Marta123ORCID,Mont Lluís123ORCID,Guasch Eduard123ORCID

Affiliation:

1. Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain

2. Institut d’Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain

3. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain

4. Electrophysiology and Heart Modeling Institute (IHU LIRYC) Pessac France

5. Université de Bordeaux Bordeaux France

6. Department of Cardiology and Angiology, Charite ́ University Medicine Berlin, Charite ́ Campus Mitte Berlin Germany

7. DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany

8. Centro de Investigación Biomédica en Red de Salud Mental Instituto de Salud Carlos III Madrid Spain

9. ADAS 3D Medical SL Barcelona Catalonia Spain

Abstract

Background Left atrial structural remodeling contributes to the arrhythmogenic substrate of atrial fibrillation (AF), but the role of the right atrium (RA) remains unknown. Our aims were to comprehensively characterize right atrial structural remodeling in AF and identify right atrial parameters predicting recurrences after ablation. Methods and Results A 3.0 T late gadolinium enhanced–cardiac magnetic resonance was obtained in 109 individuals (9 healthy volunteers, 100 patients with AF undergoing ablation). Right and left atrial volume, surface, and sphericity were quantified. Right atrial global and regional fibrosis burden was assessed with validated thresholds. Patients with AF were systematically followed after ablation for recurrences. Progressive right atrial dilation and an increase in sphericity were observed from healthy volunteers to patients with paroxysmal and persistent AF; fibrosis was similar among the groups. The correlation between parameters recapitulating right atrial remodeling was mild. Subsequently, remodeling in both atria was compared. The RA was larger than the left atrium (LA) in all groups. Fibrosis burden was higher in the LA than in the RA of patients with AF, whereas sphericity was higher in the LA of patients with persistent AF only. Fibrosis, volume, and surface of the RA and LA, but not sphericity, were strongly correlated. Tricuspid regurgitation predicted right atrial volume and shape, whereas diabetes was associated with right atrial fibrosis burden; sex and persistent AF also predicted right atrial volume. Fibrosis in the RA was mostly located in the inferior vena cava–RA junction. Only right atrial sphericity is significantly associated with AF recurrences after ablation (hazard ratio, 1.12 [95% CI, 1.01–1.25]). Conclusions AF progression associates with right atrial remodeling in parallel with the LA. Right atrial sphericity yields prognostic significance after ablation.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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